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Arizona rates for HCPCS A9571

Indium In-111 labeled autologous platelets, diagnostic, per study dose

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,092.08 / $4,092.08 / $4,092.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,171.21 / $8,245.66 / $13,062.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,879.61 / $3,839.48 / $18,597.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $4,294.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,294.16 / $4,294.16 / $4,294.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,092.08 / $5,106.38 / $18,944.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $9,135.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.96 / $4,209.96 / $4,209.96